Photo of a healthcare professional analyzing a heart rhythm on a tablet device

Top 10 Population Health Management Tools

1 Sep 2015 by Christine Kern

As healthcare costs continue to rise and as the number of individuals who now have access to healthcare through Obamacare increases — putting more pressure on healthcare providers — greater emphasis is being placed on the need for new approaches on how healthcare is delivered. 

Population Health Management (PHM) is the aggregation of patient data across multiple health information technology resources; the analysis of that data into a single, actionable patient record; and the actions through which care providers can improve both clinical and financial outcomes.

According to American Health Information Management Association (AHIMA), PHM is an ideal way to refocus healthcare in order to pre-empt many costly health conditions and reduce overall healthcare costs.  The Institute for Health Technology Transformation (IHTT) 2012 report stated, “PHM focuses partly on the high-risk patients who generate the majority of health costs. It systematically addresses the preventive and chronic-care needs of every patient. Because the distribution of health risks changes over time, the objective is to modify the factors that make people sick or exacerbate their illnesses.”

Here are some of the top trends in PHM, and how they help reduce costs and improve outcomes:

Electronic Health Records (EHRs): EHRs are useful in documenting and enabling sharing of pertinent patient diagnoses, vital signs, tests and treatments, registry populations and other structured data necessary for advanced analytics. Health IT Outcomes reported that a study from Kalorama showed the market for replacing EHRs is expected to steadily increase at 7 to 8% over the next five years. According to the study, “Approximately a third of hospitals with EMRs are dissatisfied with their purchase.”

Patient registries: These comprise the central database of PHM and are used for patient monitoring, patient outreach, point-of-care reminders, care management, health-risk stratification, care-gap identification, quality reporting, performance evaluation and many other purposes. One recent example is the American College of Cardiology’s launch of two Afib-related registry programs to track ablation and left atrial appendage occlusion procedures.

Health Information Exchange (HIE): HIEs allow for effective coordination of care across the healthcare field, connecting patients and healthcare team members by allowing for secure and confidential sharing of pertinent healthcare information.

Risk stratification: Risk stratification and predictive modeling applications provide a way for healthcare professionals to intervene appropriately with high-risk or potentially high-risk patients to forestall major medical events.

Automated outreach: Combining analytics with registries, healthcare providers can generate automated messages for patients who require preventive or chronic-disease care, based on standardized clinical protocols, and drive adherence and gather data within population health programs.

Referral tracking: This allows healthcare providers to keep track of referrals to other providers to ensure that results from these consultations are received and entered into the patient records.

Patient portals: The use of patient portals has increased recently as a means to engage patients in their health and wellness, and it allows for patients to check accuracy of records. Currently, however, despite their potential, reports show that portals are being underused by physicians.

Telehealth/telemedicine: Telemedicine includes treatment of patients via audio and video conferencing to engage and care for patients between face-to-face office visits and help reduce overall healthcare costs. Yet a recent study demonstrated that less than 10% of patients currently use telehealth services. 

Remote patient monitoring: Remote monitoring, often connected to healthcare apps, can help patients control chronic conditions such as hypertension or diabetes and forestall major health events by identifying issues early.

Advanced population analytics: These can be used to evaluate how different segments of populations are faring, and to assess the clinical and financial performance of individual providers, sites of care and the healthcare organization as a whole. Using predictive analytics, for example, can help reduce readmissions by assessing patient risks of readmission.

Let Insight help your healthcare organization find and deploy the best technologies for your unique needs in order to increase efficiency, decrease costs and improve patient outcomes. Call 1.800.INSIGHT or visit online.